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The causes of tired all the time TATT is endless: underactive thyroid gland, diabetes, depression, cancer, shift work, anaemia, carbon monoxide poisoning, … One possible if under-considered explanation is sleep apnoea. This is a sleep disorder in which someone briefly, but repeatedly, stops breathing during the night. Sleep apnoea has serious consequences for health, including an increased risk of stroke and heart disease.
A recent Swiss study suggests that up to one in two men and one in four women has problems with their breathing at night. Normally, as you drift off, the countless small muscles of the walls of your airway slacken a little. However, if your airway is narrow enough or becomes sufficiently floppy, it can become partly or completely obstructed.
This collapse results in oxygen levels falling and the heart rate increasing, disrupting your sleep in order for muscle tone to return briefly to the airway, allowing you to breathe again. This can happen ten, 20 or even, in rare cases, 100 times an hour. The rates of sleep apnoea have increased in parallel with our girths and neck circumferences.
Fat around the neck makes the airway narrower and more likely to collapse, while fat on the chest increases the effort of breathing. But obesity is not the only cause of sleep apnoea. It may run in families and is often related to the shape of the airway. A large tongue, recessed lower jaw and large tonsils can cause a narrowing, to
It also appears to be more common in people of South-East Asian ancestry. It is more common, too, in older people, possibly because changes to muscle as we age mean the airway is more likely to collapse in on itself. Snoring can be a warning sign, but it is not just a snoring problem. Having your sleep disrupted several times an hour, results — unsurprisingly — in excessive sleepiness during the day.
Sleep apnoea has costs beyond tiredness. With each obstruction and brief suffocation, there is a surge of noradrenaline (a stimulating hormone), a rise in heart rate and blood pressure, a stiffening of the arteries and a drop in oxygen levels. With each pause in breathing, changes to blood flow back to the heart result in altered levels of a hormone called ANP, which means the kidneys continue to produce more urine than they otherwise would at night.
This results in more frequent nocturnal urination.Over time, these physiological changes can lead to permanently high blood pressure and, in turn, the serious problems it causes such as heart disease and stroke.
This results in more frequent nocturnal urination.Over time, these physiological changes can lead to permanently high blood pressure and, in turn, the serious problems it causes such as heart disease and stroke.
There is also a link with short-term cognition problems, such as concentration, and possibly long-term with Alzheimer’s disease (see panel, far right). While high blood pressure is one of the largest risk factors for cardio- vascular disease and stroke, there seem to be additional effects of having sleep apnoea that may play a part. Experimental research into recurrent drops in oxygen suggests that these fluctuations can cause the thin lining of the blood vessels to stop working as it should. Known as the endothelium, this lining has an important function: it detects changes in blood flow and releases substances that regulate the size and thickness of blood vessels in response.
Dysfunction of the lining is considered an early stage of cardiovascular disease.
There are various treatments for sleep apnoea. Weight loss helps, and for some patients options include not sleeping on their back and oral devices to hold the lower jaw forward and open up the airway. More recently, for very serious cases, an electronic device can be implanted in the neck to stimulate the nerve that retracts the tongue in sleep. At the time, however, there was really only one choice for Maria — CPAP, or continuous positive airway pressure.
There are various treatments for sleep apnoea. Weight loss helps, and for some patients options include not sleeping on their back and oral devices to hold the lower jaw forward and open up the airway. More recently, for very serious cases, an electronic device can be implanted in the neck to stimulate the nerve that retracts the tongue in sleep. At the time, however, there was really only one choice for Maria — CPAP, or continuous positive airway pressure.
This device consists of a face mask attached to a small machine that pumps out pressurised air that keeps the airway open during sleep. Benefits of CPAP on cognitive functioning, mood and sleepiness have clearly been demonstrated. We also know that CPAP results in an improvement in blood pressure and the function of the endothelium. The research is less clear on whether it can reduce the risk of longer-term problems such as the risk of stroke or heart disease.